Question

Discuss of the questions raising your own opinion and provide examples from KSA or globally to support your ideas

1-How can patients be helped to maintain control over the end of their lives?

2-How should doctors respond to requests from relatives to keep information from the patient?

Answer 1

More people are living into old age and facing fears about death and the prospect of long-term illnesses associated with aging. Psychologists who are trained to pay attention to the special needs of older adults at the end of life will be able to make a major impact in the quality of the death experience for both patients and their families. And also the nurse has to meet the needs and demands of patients whoever are at the end of lives. There is .an increased role for psychologists in encouraging older adults to complete advance directives regarding their wishes for end-of-life care, transitioning terminally ill patients from hospitals to hospice and palliative care to maximize their quality of life and providing psychological services to these patients and their families.

1. Encouraging use of advance directives:

Advance directives, such as durable powers of attorney or living wills. Such steps can allow older adults to receive the kind of end-of-life care they prefer if they become incapacitated due to illness. Health care professionals can help patients face the need for such advance planning and think through their wishes and values.

Conducting careful psychological assessments:

Psychological assessment may identify undetected problems including dementia, delirium, anxiety, depression and behavioral disturbances. We can take roles in managing these problems if diagnosed. Psychologists can provide assessments of levels of deterioration in patients with dementia and delirium. It is key to helping family members and health-care workers determine patients' capacity for making their own health-care decisions.

Treating psychological stress associated with death :

We can help patients in communication with their health-care team, find meaning in their lives, maintain their social connections and supports, address unfinished business with family members and maintain a sense of control over their dying process.

Guiding family members through difficult decisions:

Family members may not understand the level of psychological deterioration in their elderly loved-one, so it's crucial to prepare them for likely personality changes and cognitive decline. Families may also have to make difficult decisions, such as whether to withhold treatment that would extend life in patients with a poor quality of life. We have to discuss with them in making decisions that are crucial.

2. The medical staff generally includes family members when caring for their loved ones.

Patients have the right to obtain information from the medical record.

A patient's family members may obtain information regarding the patient if they have a waiver of medical confidentiality signed by the patient.

Appropriate information sharing is an essential part of the provision of safe and effective care. Patients may be put at risk if those who provide their care do not have access to relevant, accurate and up-to-date information about them. Multidisciplinary and multi-agency teamwork is also placing increasing emphasis on integrated care and partnership working, and information sharing is central to this, but information must be shared within the framework provided by law and ethics.

As a doctor he might need to share personal information with a patient’s relatives, friends or carers to enable to assess the overall benefit to the patient. But that does not mean they have a general right of access to the patient’s records or to be given irrelevant information about, for example, the patient’s past healthcare.

He has to share relevant information with anyone who is authorized to make health and welfare decisions on behalf of, or who is appointed to support and represent, a patient who lacks the capacity to give consent. This might be a welfare attorney, a court-appointed deputy or guardian, or an independent mental capacity advocate, and should also share information with independent mental health advocates in some circumstances